The title of a recent National Post article is a good summary of new discussions I have had with several clients about personal planning in light of COVID-19.
“Some critically ill COVID-19 patients choosing to die at home rather than be treated with ventilator in ICU”
Here we are in the throes of a worldwide health pandemic and the need for ventilators continues to grow. As COVID-19 infections do battle with a person’s lungs, breathing functions can be crippled. According to the World Health Organization, 1 in 6 COVID-19 patients becomes seriously ill and has difficulty breathing. According to the Journal of the American Medical Association, more than 40% of COVID-19 patients will develop acute respiratory distress syndrome. In such situations, ventilators can keep patients breathing and give their bodies a chance to fight the virus.
Hooking up COVID-19 patients to ventilators can occur in a few different ways, ranging from invasive to relatively non-invasive. In less critical cases, oxygen can be delivered through a face mask rather than a tube. If a more invasive procedure is required, a scope is inserted into the patient’s mouth and a tube is guided into the patient’s windpipe and attached to the mechanical ventilator. An even more invasive procedure requires an incision be made in the patient’s windpipe for the tube’s insertion. The use of a ventilator is potentially a life-saving treatment for COVID-19 victims.
However, in making the decision to accept ventilation, a patient must weigh the benefits against the potential consequences in light of the patient’s medical wishes. According to the National Post article, “… a number of elderly patients have died in long-term care homes rather than submit to intensive therapy that might have only made their passing more painful and uncomfortable.” Further, doctors are asking “…Canadians to consider now whether they would want the full panoply of ICU care should COVID-19 make them severely ill, especially given research showing survivors of such treatment often fare poorly over the long term.” Have you asked yourself this question? Do you want mechanical ventilation should you become afflicted with COVID-19 and your condition deteriorates? This is not a simple question to ask, but is one that must be answered.
Like other hospitals across the country, the University of Toronto’s critical care medicine department recently developed guidelines urging health care workers to ask COVID-19 patients at the time of admission to set out the patient’s medical treatment goals; the question is asked early in the admission process due to the potential for the patient’s rapid deterioration if low oxygen levels occur. These questions not only ensure the patient’s medical wishes are made known and followed, but can reduce the unnecessary use of limited critical care supplies.
It is very important for a patient, whether a COVID-19 patient or otherwise, to communicate their medical wishes to their health care workers, caregivers and loved ones. The time may come when you may not be able to communicate your beliefs and wishes for medical treatment at a time when a treatment decision must be made. There is no time like the present to reflect and write down your beliefs and wishes for future health treatment; you can take control and let your decisions be known if you should ever be unable to communicate your future decisions yourself.
An Advance Directive allows you to state your decisions about accepting or refusing health care treatments, including life support and life-prolonging medical interventions such as mechanical ventilation, directly to your health care worker. Your wishes as set out in your Advance Directive must be followed when the Directive addresses the health care decision needed at the time. Unless you otherwise instruct in writing, no one will be asked to make a decision for you and your wishes as outlined your Advance Directive will be followed. If a health care decision must be made that is not addressed in your Advance Directive, a Temporary Substitute Decision Maker (TSDM) will be chosen to make that health care decision for you if you are incapable of doing so. Your TSDM will be chosen by your health care provider based upon a list determined by B.C. law unless you appoint a proxy to make such decisions on your behalf in a Representation Agreement.
Ensuring that your voice is heard in decisions made about your health care is important and there are several steps that you can take now, while you are capable, to put an advance care plan in place. Taking the time to develop your advance care plan will provide you with comfort in knowing that your family, friends and health care workers know your wishes and having those wishes carried out.
You can make a choice now to speak to your doctor and your lawyer to develop your advance care plan.